I won’t bore you with the origins of this debate. OK, maybe I will a little, but I’ll try to make this foray into meta-blogging interesting.

First, blogging is not scientific writing as such. It isn’t peer reviewed, it isn’t a systematic presentation of research—it’s whatever the author feels like writing about that day. Now for various reasons, many bloggers write under a pseudonym. There are many reasons for this. First, most of us are not professional writers by trade, so we don’t care as much about being identified with our work. Second, given our fields, many of us wish to avoid having our colleagues or patients identified serendipidously. Lastly, some of us are early in our careers and might not wish to be identified with our non-professional writing.

This leads to some interesting conflicts. In my field (internal medicine), we often revere our older, smarter colleagues for their diagnostic and therapeutic acumen. Their skills may arise from experience, reading, research, or, more likely, all of the above. Many physicians improve with age and experience—diagnosis, in particular, relies on pattern recognition, and experience may improve this. And while we may respect our elders for these abilities, we temper this with the knowledge that most medical decision making must be viewed through the lens of evidence-based medicine—just because Dr. X, said it, that doesn’t make it so—but it may improve the likelihood of it being true. Still, show me the evidence! Of course, when you first see a patient, you form diagnostic impressions without the help of evidence-based diagnostic procedures. These impressions help you decide how to proceed. When you read something by a pseudonymous blogger, you don’t have any clear idea of the level of authority of your source.

(OK, I said I’d try to make this interesting. Sorry.)

Experience counts for a lot in medicine. Authority figures mean something. If someone says to me, “I think he might have lupus…that’s what Dr. Random Guy thinks,” I’m less likely to care than if they say, “Dr. Landsberg thinks the guy’s got lupus.” I know that Landsberg has the judgment, experience, and knowledge to make good diagnoses. I know that he wouldn’t just throw a disease name out there.

But I know this because I knew the man, I read his writings, I saw him work. I knew him to be good based on what he did. I accepted him as an authority, and if I asked his opinion, I’d be willing to believe it.

In medicine, no one specializes in everything. We rely on our colleagues in various sub-specialties to help us out with our patients. We don’t check up on every decision they make, every bit of data they collect, because we can’t.

And here is one of the core issues about authority and science on the web. When you write about science, “because I said so” is not useful evidence. But in transmitting these ideas in writing, no one expects to know everything you do. It’s just not possible.

There is a balance in scientific blogging between giving evidence for every fact we jot down and saying, “hey, I’m a doctor, trust me on this one.” This intersects with some of the principles behind denialism—the reliance of fake experts, and the logical fallacy of “appeal to authority”.

If you don’t trust your source, no amount of evidence they give may convince you. If you trust your source too much, you may be lulled into a false sense of fact-security. But we all must rely on experts at some point.

We all must beware of what we read, and judge its content based partly on the source. If the source agrees with other reputable sources, that is a mark in its favor. It it is sitting alone in the woods crying “Conspiracy!”, well, the trust level drops a bit.

This has nothing to do with qualifications, pseudonyms, or any other blogorrhea. It’s about how to read science. Read as much as you can, from as many reliable sources as you can, and if you are interested in a particular topic, keep up on it, as facts will change.

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Comments

The great Richard Feynman once snapped at a Caltech student wanting to know well-known cosmologist Michael Turner’s bias on a matter, “Why do you want to know his bias? Form your own bias!” (Paraphrased from Perfectly Reasonable Deviations From the Beaten Track.)

Even though a respected authority himself, he never liked people to accept things uncritically.

Still for the layperson, there comes a point where a person’s expertise is exceeded, and authority must be relied upon. No one can be an expert in everything. This is a problem for things like global warming, where consensus must be relied upon by the layman. There’s line somewhere, but I’m not so sure where to draw it.

Well said. It should be noted that the process you describe is really how we “know” anything. A person may begin with an opinion and then the four E’s arrive; Experience, Extrapolation, Examination and Error. A person may believe that vaccines cause autism – they have an opinion and through limited examination and extrapolation they may reinforce this notion. However, if they neglect to factor in experience and examination – they will remain stuck in a false premise.

The internet is awash with self proclaimed experts on almost every subject conceivable. One of my favorites is a guy named John Major Jenkins – who is a self proclaimed expert on mesoamerican astroarchaeology. He also has the incredible notion that the Mayans somehow had prescient astronomical powers and could detect and predict things no technolgoy can duplicate.

I would imagine that the basis of a denialist viewpoint (I sitll don’t like that term) could be quickly determined from a gap in one of the four E’s – most likely Examination (that is objective, critical analysis).

You write: “Quite often, patients eschew advice based on years of hard, scientific work, and ask him about the latest miracle cure. This makes him cranky.”

Well it shouldn’t. Yours is a reliance on authority and white lab coat, quite common. But the patient knows more than you about many things in his world. For example, Have you been to his house? Have you met his relatives? Are their poisons at his workplace? Are their stresses to his system you are not aware of? Also, have you actually seen the trial reports on a drug you choose or did you rely on an authority, specifically the drug salesman to tell you about it?

And who is this patient? Eschewing advice by one patient is not the same as eschewing by another. To take a jaded example, Einstein, “let it burst.” Perhaps a second reason he did not wear socks.

There is every reason to question the doctor, from bloodletting to faulty drug research. Your job as I see it is not only authority, which is doctrine, but practical application, which is open to question, and you should explain no matter how lowly the patient.